The Hemodynamically Significant Ductus Arteriosus in Critically Ill Full-Term Neonates

Abstract

In premature infants, the clinical effects and management of a hemodynamically significant patent ductus arteriosus (HSDA) are well-described. In full-term neonates the ductus arteriosus (DA) is rarely monitored except in cases of concomitant pulmonary hypertension or duct dependant congenital heart disease. Although systemic–pulmonary shunting commonly occurs in mature infants, coinciding with the normal postnatal fall in pulmonary vascular resistance, cardiac failure in the neonatal period is rarely attributed directly to the DA. In this case series, we report two full-term infants who were initially treated for pulmonary hypertension and myocardial dysfunction but developed clinical, radiographic and two-dimensional echocardiographic evidence of cardiac failure secondary to a large unrestrictive patent DA (PDA). One patient was treated with indomethacin, and, although transductal diameter decreased, there was no clinical benefit. Cardiac failure resolved and myocardial function improved in both cases after PDA ligation. We suggest that PDA be monitored closely in neonates recovering from PPHN who have ongoing oxygenation difficulties or myocardial failure. PDA ligation should be considered an option for full term neonates with cardiac failure secondary to a HSDA when other therapeutic options fail.

Prostaglandin E1 in infants with congenital diaphragmatic hernia (CDH) and life-threatening pulmonary hypertension

“…Cases of right ventricular failure have been reported when the ductus arteriosus closes in newborn infants with PPHN (16). In our study, pulmonary hypertension did not respond to inhaled NO.…”

“…Sixteen were excluded because they received PGE1 prophylactically before any clinical worsening. Eighteen CDH infants were treated with PGE1 for acute life-threatening suprasystemic pulmonary hypertension during the course of the hospitalization at a median postnatal age of 11 days, IQR [5][6][7][8][9][10][11][12][13][14][15][16] (Fig 1 ).…”

Insights into the Pathogenesis and Genetic Background of Patency of the Ductus Arteriosus

“…In 90% of healthy term babies, the DA is functionally closed by 72 h of life [5] . Term infants with respiratory failure show a significant delay in ductal closure within the first 24 h of life [6] and sometimes suffer from a hemodynamically significant patent DA that requires treatment [7] . Causes for the prolonged patency of the DA can be structural, as well as functional, immaturity and altered physiological conditions.…”

Percutaneous closure of a patent arterial duct in a newborn

“…Although patency of the arterial duct is common in preterm neonates, in some neonates the persistently patent ducts need to be closed at term. 3,4 Our patient had multiorgan failure related to its persistent patency, with surgical or pharmacological closure contraindicated because of cerebral bleeding, acute renal failure, and profound thrombocytopaenia. To the best of our knowledge, percutaneous ductal closure has not previously been reported in neonates.…”